On the Topic of Enhanced Recovery After Surgery

By | April 23, 2019

In over sixteen hundred articles published since 2000, the value of enhanced recovery after surgery (ERAS) is irrefutably clear – “ERAS optimizes operative functional status to improve clinical outcome and patient satisfaction.” ERAS concepts are a comprehensive patient care movement that originated in Europe. By treating undesirable perioperative pathophysiologic processes, like colorectal surgery, which was the first surgery in which the protocol was implemented, a speedy patient recovery can occur. Furthermore, in this population, data indicates that these pathways reduce complication rates and shorten the time of recovery. Reductions in length of stay also occur.

The five key components of ERAS are preoperative education, the use of epidural analgesia for pain relief, avoidance of nasogastric tubes, early mobilization, fluid therapy targeting euvolemia, and early feeding. Moreover, plenty of these protocols are translatable to other surgical types.

As we continually evolve and implement models that show benefit in one area, it is imperative that we study the results in other situations. Though it appears logical that the same benefits will occur, there is not a guarantee of success due to various factors. There are possible physiologic differences that might create situations that do not respond in the same way. Also, providers expand the scope of the pathways by adding other interventions without careful study to evaluate if these additional components of the protocol add individual value.

If we wait for the data to support what conceptually makes sense based on other studies, we will lose ground on delivering value. However, we must always expand our knowledge of the validity of our interventions. Otherwise, we will add operational complexities when no benefit occurs. Secondarily, if we fail to obtain the same outcomes, we may assume the model itself is faulty, and not implement it at all, versus understanding the issue might be due to a different disease process or patient type. Thus, we need to look ERAS from more than one angle.

Let us be aggressive not only continuing to innovate but also in what we study. ERAS and its components have enormous potential to improve the quality of care and decrease costs. Diligence in its implementation and maintaining a scientific approach to our results will only aid us in our continual desire to be a learning field.